1427155647 NPI number — WARREN H. PHILLIPS, III, PHD PC

Table of content: (NPI 1427155647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427155647 NPI number — WARREN H. PHILLIPS, III, PHD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WARREN H. PHILLIPS, III, PHD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTRAL IOWA PSYCHOLOGICAL SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427155647
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3737 WOODLAND AVE
Provider Second Line Business Mailing Address:
SUITE 415
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-222-1999
Provider Business Mailing Address Fax Number:
515-224-3949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3737 WOODLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 415
Provider Business Practice Location Address City Name:
WEST DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50266-1937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-222-1999
Provider Business Practice Location Address Fax Number:
515-224-3949
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
WARREN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER-PSYCHOLOGIST
Authorized Official Telephone Number:
515-222-1999

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0047894 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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